Patient Complexity and Risk Stratification in Modern Cardiac Surgery

Cardiac surgery is increasingly performed in patients characterized not only by cardiac pathology, but by substantial biological and systemic complexity. Frailty, metabolic disease, obesity, and sex-related vulnerability frequently shape perioperative trajectories, challenging the adequacy of a predominantly heart-centered framework for interpreting outcomes in contemporary practice. Despite major advances in surgical technique and perioperative care, perioperative morbidity remains substantial. Prolonged intensive care stay, delayed recovery, and non-cardiac organ dysfunction often follow technically successful procedures.